Know Your Numbers!

John F. MacGregor, MD
March 1, 2008

I recently participated in a series of interviews with the Cascade Radio Group, discussing my strong belief that patients need to participate actively in their health care.  A central theme of those interviews was the phrase, "Know your numbers!"  In particular, I believe we should all know our current blood pressure and cholesterol levels, our goal levels, and how we might go about achieving those goals.

Blood pressure is the force of blood pushing against the walls of your blood vessels as your heart pumps the blood around your body.  It is measured as a systolic number (when the heart beats) over a diastolic number (when the heart rests between beats), such as 125/75.  Blood pressure levels above the desirable range qualify as high blood pressure, which we call hypertension; it is the number one cardiovascular killer in the United States.  One in three American adults has hypertension.  Since there are rarely symptoms related to hypertension, we often call it the "Silent Killer."  Even if you're on medication for hypertension, you still have that condition; it is important to understand whether your hypertension is well-treated (at goal) or not.  For all of us, a systolic pressure over 140 and/or a diastolic pressure over 90 qualify as hypertension.  Diabetic patients are at greater risk for complications from hypertension; their goal is a blood pressure always below 130/85.  We now also understand that blood pressure represents a continuum of risk: in other words, a blood pressure of 139/89 does not mean you have nothing to worry about.  In fact, the range of 120-139 systolic, or 80-89 diastolic, is now classified as "prehypertension," and bad things are more likely to happen in that range than if your blood pressure is below that range.  In a perfect world, we would ALL have blood pressure below 120 systolic and below 80 diastolic - that is an unrealistic goal, but any little step each of us can take in that direction can help prevent complications such as heart attack and stroke.  What are your numbers?

Cholesterol management can seem complicated, because we measure more than one type of cholesterol and call some of it "good" and some of it "bad."  There's the total cholesterol level, then the level of the different types that we can measure contributing to that total: low-density lipoprotein (LDL), high-density lipoprotein (HDL), among others.  The bottom line: LDL is the bad stuff, so we want Lower levels.  HDL is the good stuff, so we want Higher levels.  Lower for LDL, Higher for HDL.  That can help simplify matters.  Again, we now know that there is a continuum of risk, so you should know where you fall along that curve.  Total cholesterol levels below 200 are best; in the range of 200-239 are 'borderline high,' and above 240 are definitely too high.  LDL levels of 100-129 are optimal, 130-159 are borderline high, and 160 or above are too high.  If you have diabetes or cardiovascular disease, your goal LDL level is below 100; however, most of us in cardiovascular medicine will try to get your LDL down below 70 if possible, as studies have shown lower risk to you if we can do that.  HDL is the opposite: we want your HDL above 60 if possible.  40-59 is acceptable for some.  Below 40 (in men) or 50 (in women) is too low, and there is greater risk of heart attack and stroke.  We also measure triglycerides, which are a storage form for fat in your body.  The desirable range is below 150; 150-199 is borderline high, and above 200 is definitely too high.  What are your numbers?

For more information, your primary care provider is always a good place to start.  Another great resource is the American Heart Association website, at www.americanheart.org.  From the main page, you can access more detailed information about blood pressure, cholesterol, and other conditions that can impact your health.  Strategies for achieving your goals are discussed.  There are even quizzes you can take to test your knowledge, and tools you can use to track your levels over time.  Don't wait!  The time is NOW to get involved and Know Your Numbers!

This article was written by Dr. John F. MacGregor, part of the team North Cascade Cardiologists. They are a dedicated group of cardiologists and professional staff whose focus is providing the best possible patient care and experience, while advancing the understanding of heart disease. For more information call 1-888-739-2700.